Health insurance is a type of protection that covers medical expenses that can arise due to an illness or an unfortunate accident. These expenses could be related to hospitalisation costs, cost of medicines, diagnostics expenses, doctor consultation fees and ambulance charges etc. Taking health insurance is must for an individual or family given the rising costs of treatment and hospitalization.
What are the types of Health Insurance?
There are two types of health insurance - Mediclaim plans and Critical illness insurance plans.
Mediclaim Plans
Mediclaim plans are the most basic type of health insurance plans available in India. They cover the cost of treatment when you are hospitalized due to some sickness or accident. The payout is made on expenses incurred in the hospital by submission of original bills. Mostly Mediclaim plans are cash less and payment is made to the hospital directly by the insurance company.
There are broadly 3 types of mediclaim plans -
Critical Illness Insurance Plans
Critical Illness Insurance Plans cover a range of life threatening diseases which might require prolonged treatment at hospital or at home. Unlike mediclaim plans, the payout (critical illness cover amount) is made immediately on diagnosis of the critical illness without having to submit any medical bills. While the mediclaim policy pays for the hospitalization cost, critical illness plan provides you the flexibility to use the payouts for change in lifestyle expenses that may occur due to the illness, treatment at home or as a substitute for loss of income due to prolong absence from work.
What does a Mediclaim Policy cover?
Generally it covers hospitalization charges like room & ICU rent, operation theatre charges, cost of medicines, cost of oxygen, doctor visit, diagnostic and other direct charges incurred in course of the treatment. It also covers day care treatment cost in case 24 hours of hospitalization is not required due to advanced treatment procedures applied for treatment of the illness.
Who can buy a Mediclaim Policy?
Generally, all insurance companies allow a person between the age of 18 to 65 years to buy a mediclaim policy. Children under age 18 are also allowed provided their parents are covered under the policy. Generally these covers come under family floater mediclaim plan wherein the kids along with their parents are covered through a single policy.
How does Mediclaim Policy work?
The claim under a Mediclaim Plan is paid by two ways - Through Cashless procedure or reimbursement of bills. Nut, these days, it is mostly the Cashless procedure.
Cashless procedure - In this procedure the policyholder does not have to pay for the hospital bills out of his pocket. Instead, he can notify the insurance company that he would be availing medical care at the company designated hospital and the company will pay the bills directly to the hospital after the treatment. In other words, even if the policyholder does not have the money for medical treatment but have a mediclaim policy, cashless mediclaim covers the medical and hospitalization needs.
Reimbursement of bills - Most of us take care to select a good mediclaim policy that could sufficiently safeguard us and our family's medical expenses. What we often tend to overlook is the procedures involved for reimbursement of the expenses. Even though the insurer reimburses you for medical expenses incurred after completion of treatment, this means that you need to pay out of your pocket during the treatment period. In case you do not provide the necessary paperwork or formalities as per the insurer's requirement, the bills might not even be reimbursed by the insurance company. This is why cashless procedure is better.
Should you buy a Mediclaim Plan or a Critical Illness Insurance plan
A mediclaim plan will either settle the hospital bills via a cashless facility or reimburse all your hospitalisation expenses on production of bills. In a critical illness insurance plan you get a lump sum payout on detection of the critical illness and for which hospitalization is not required. That is why you need both the plans - a Mediclaim plan to cover your hospitalisation expenses and a critical illness insurance plan to cover your other expenses and recover loss of income that arises because of a critical illness.
In summary, health insurance is the most important insurance cover that you should have. Choose an individual or a family floater plan as suitable to you and relieve yourself and your family from the worries of rising health care costs.